"The January 14 FAQs signaled that the DOL is poised to undertake enforcement actions against owners of the provider networks if they continue to refuse to share the data. Such enforcement actions may become a priority for the incoming DOL Secretary, Lori Chavez-DeRemer, who is already on record demanding that plan sponsors/business associates must have access to the plan's health claims data."  MORE >>

"[HHS] notes that the proposed rule, if finalized, would reduce enrollment, premiums, and advance premium tax credits each year beginning in 2026.... [T]his article discusses proposed policies to limit the annual OEP, eliminate the monthly SEP for low-income consumers, impose SEP verification requirements, eliminate eligibility for Deferred Action for Childhood Arrivals (DACA) recipients, allow insurers to condition new coverage on repayment of premium debt, require premiums for those who are automatically reenrolled in new coverage, treat gender-affirming care as non EHB, revise standards that apply to brokers, and revise methodologies and policies that apply to the premium adjustment percentage and actuarial value."  MORE >>

"Effective beginning with 2026 plan years, the proposed regulations would amend existing rules to prohibit health insurers of non-grandfathered small group health and individual coverage (which are subject to the ACA's EHB requirements) from covering sex-trait modification."  MORE >>

"According to the court, it was not clear whether the administrator applied the plan's utilization review process or otherwise considered whether to provide the requested single case agreement. And even if the exception request was considered, the lack of explanation in the notices left the court unable to review whether the denial was supported by substantial evidence." [Doe v. Deloitte LLP Grp. Ins. Plan, No. 23-4743 (S.D.N.Y. Feb. 24, 2025)]  MORE >>

"Providing a single-point solution that helps employees manage multiple conditions can improve their health, consolidate benefits and cut down on employer costs.... [S]ix in 10 have at least one chronic illness ... [T]he majority of healthcare costs are connected to patients with these issues. In addition to direct costs, research from multiple sources puts employer financial loss -- due to lost productivity and absenteeism -- in the hundreds of billions. Management of chronic conditions means higher prescription drug usage and cost, as well."  MORE >>

"Companies can support employees with mental health benefits, including education and training about how employees can access these benefits. HR professionals must be intentional in this training and measure results in employee knowledge and engagement in this area, as the following survey results show a bleak picture."  MORE >>

"Captives are alternative risk management programs that offer several advantages for well-qualified employers, especially in the areas of cost savings, design flexibility, and claims management. While this risk solution can present new opportunities, it also comes with its own set of challenges and questions that management teams need to address."  MORE >>

"[T]he Chronic Disease Flexible Coverage Act [HR 919] ... would codify IRS Notice 2019-45, which expands the list of preventive care benefits that can be provided by a high-deductible health plan (HDHP) with no (or low) cost sharing."  MORE >>

"Nationally, telehealth claim lines increased from 4.82 percent of medical claim lines to 5.04 percent, a 4.5 percent increase. In the Midwest, the increase was 5.6 percent; in the Northeast it was 3.1 percent; and in the South it was 4.7 percent. In the West, however, telehealth claim lines decreased by 0.9 percent. The data represent the commercially insured population, excluding Medicare Fee-for-Service, Medicare Advantage and Medicaid."  MORE >>

"[R]oughly 88% of HSA holders kept their accounts entirely in cash in 2021. [The authors] generally suggest keeping two to three years' worth of routine medical expenses in cash, cash investments, or similar low-volatility investments within your HSA. Account holders who don't invest their excess HSA contributions could be missing an opportunity to earn tax-free returns."  MORE >>

"The EveryBODY Covered campaign encourages employers to prioritize obesity within workplace healthcare and equity strategies by: [1] Recognizing obesity as a chronic disease with causes that include those outside of an individual's control.... [2] Reviewing your benefits offerings for opportunities to better support obesity care for your employees and communicate coverage as a priority to your benefits administrators.... [3] Working against weight bias at every level of your company and making sure that this is demonstrated through your company's culture."  MORE >>

"Furloughed federal workers will maintain their coverage under the Federal Employees Health Benefits Program during a lapse in appropriations. Premiums will accrue over the course of a shutdown, but will then be deducted from employees' first paychecks after agency funding has been restored.... Federal retirees enrolled in both the Civil Service Retirement System and Federal Employees Retirement System will still receive their scheduled annuity payments during a shutdown. Contributions to the Thrift Savings Plan will be halted until the government reopens ... Federal workers cannot substitute leave or unpaid furloughs when the government shuts down."  MORE >>

"[T]he Acting General Counsel of the [NLRB] recently rescinded, via Memorandum GC 25-05, more than 30 Biden Administration memoranda. Chief among the rescinded memoranda is the NLRB's 2023 guidance [Memorandum GC 23-05] regarding non-disparagement and confidentiality provisions included within non-managerial employees' severance agreements, which followed the NLRB's February 21, 2023 decision in McLaren Macomb."  MORE >>